Adoption of laparoscopy for elective colorectal resection

A report from the surgical care and outcomes assessment program

Steve Kwon, Richard Billingham, Ellen Farrokhi, Michael Florence, Daniel Herzig, Karen Horvath, Terry Rogers, Scott Steele, Rebecca Symons, Richard Thirlby, Mark Whiteford, David R. Flum

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background: The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. Study Design: The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement benchmarking initiative in the Northwest using medical record-based data. We evaluated the use of laparoscopy and a composite of adverse events (ie, death or clinical reintervention) for patients undergoing elective colorectal surgery at 48 hospitals from the 4 th quarter of 2005 through 4 th quarter of 2010. Results: Of the 9,705 patients undergoing elective colorectal operations (mean age 60.6 ± 15.6 years; 55.2% women), 38.0% were performed laparoscopically (17.8% laparoscopic procedures converted to open). The use of laparoscopic procedures increased from 23.3% in 4 th quarter of 2005 to 41.6% in 4 th quarter of 2010 (trend during study period, p <0.001). After adjustment (for age, sex, albumin levels, diabetes, body mass index, comorbidity index, cancer diagnosis, year, hospital bed size, and urban vs rural location), the risk of transfusions (odds ratio [OR] = 0.52; 95% CI, 0.39-0.7), wound infections (OR = 0.45; 95% CI, 0.34-0.61), and composite of adverse events (OR = 0.58; 95% CI, 0.43-0.79) were all significantly lower with laparoscopy. Within those hospitals that had been in SCOAP since 2006, hospitals where laparoscopy was most commonly used also had a substantial increase in the volume of all types of colon surgery (202 cases per hospital in 2010 from 112 cases per hospital in 2006, an 80.4% increase) and, in particular, the number of resections for noncancer diagnoses and right-sided pathology. Conclusions: The use of laparoscopic colorectal resection increased in the Northwest. Increased adoption of laparoscopic colectomies was associated with greater use of all types of colorectal surgery.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
Volume214
Issue number6
DOIs
StatePublished - Jun 2012

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Laparoscopy
Outcome Assessment (Health Care)
Colorectal Surgery
Odds Ratio
Colon
Hospital Bed Capacity
Benchmarking
Colectomy
Wound Infection
Quality Improvement
Medical Records
Comorbidity
Albumins
Body Mass Index
Pathology
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Adoption of laparoscopy for elective colorectal resection : A report from the surgical care and outcomes assessment program. / Kwon, Steve; Billingham, Richard; Farrokhi, Ellen; Florence, Michael; Herzig, Daniel; Horvath, Karen; Rogers, Terry; Steele, Scott; Symons, Rebecca; Thirlby, Richard; Whiteford, Mark; Flum, David R.

In: Journal of the American College of Surgeons, Vol. 214, No. 6, 06.2012.

Research output: Contribution to journalArticle

Kwon, S, Billingham, R, Farrokhi, E, Florence, M, Herzig, D, Horvath, K, Rogers, T, Steele, S, Symons, R, Thirlby, R, Whiteford, M & Flum, DR 2012, 'Adoption of laparoscopy for elective colorectal resection: A report from the surgical care and outcomes assessment program', Journal of the American College of Surgeons, vol. 214, no. 6. https://doi.org/10.1016/j.jamcollsurg.2012.03.010
Kwon, Steve ; Billingham, Richard ; Farrokhi, Ellen ; Florence, Michael ; Herzig, Daniel ; Horvath, Karen ; Rogers, Terry ; Steele, Scott ; Symons, Rebecca ; Thirlby, Richard ; Whiteford, Mark ; Flum, David R. / Adoption of laparoscopy for elective colorectal resection : A report from the surgical care and outcomes assessment program. In: Journal of the American College of Surgeons. 2012 ; Vol. 214, No. 6.
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abstract = "Background: The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. Study Design: The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement benchmarking initiative in the Northwest using medical record-based data. We evaluated the use of laparoscopy and a composite of adverse events (ie, death or clinical reintervention) for patients undergoing elective colorectal surgery at 48 hospitals from the 4 th quarter of 2005 through 4 th quarter of 2010. Results: Of the 9,705 patients undergoing elective colorectal operations (mean age 60.6 ± 15.6 years; 55.2{\%} women), 38.0{\%} were performed laparoscopically (17.8{\%} laparoscopic procedures converted to open). The use of laparoscopic procedures increased from 23.3{\%} in 4 th quarter of 2005 to 41.6{\%} in 4 th quarter of 2010 (trend during study period, p <0.001). After adjustment (for age, sex, albumin levels, diabetes, body mass index, comorbidity index, cancer diagnosis, year, hospital bed size, and urban vs rural location), the risk of transfusions (odds ratio [OR] = 0.52; 95{\%} CI, 0.39-0.7), wound infections (OR = 0.45; 95{\%} CI, 0.34-0.61), and composite of adverse events (OR = 0.58; 95{\%} CI, 0.43-0.79) were all significantly lower with laparoscopy. Within those hospitals that had been in SCOAP since 2006, hospitals where laparoscopy was most commonly used also had a substantial increase in the volume of all types of colon surgery (202 cases per hospital in 2010 from 112 cases per hospital in 2006, an 80.4{\%} increase) and, in particular, the number of resections for noncancer diagnoses and right-sided pathology. Conclusions: The use of laparoscopic colorectal resection increased in the Northwest. Increased adoption of laparoscopic colectomies was associated with greater use of all types of colorectal surgery.",
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